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OP0169 The Effects of TNF Inhibitors, Methotrexate, NSAIDS and Corticosteroids on Cardiovascular Events in Rheumatoid Arthritis, Psoriasis and Psoriatic Arthritis: A Systematic Review and Meta-Analysis
  1. C. Roubille1,
  2. V. Richer2,
  3. T. Starnino3,
  4. C. McCourt4,
  5. A. McFarlane5,
  6. P. Fleming6,
  7. S. Siu7,
  8. J. Kraft8,
  9. C. Lynde8,
  10. J. Pope7,
  11. S. Keeling5,
  12. W. Gulliver9,
  13. J. Dutz4,
  14. L. Bessette10,
  15. R. Bissonnette11,
  16. B. Haraoui12
  1. 1University of Montreal Hospital Research Center (CRCHUM), Notre Dame Hospital
  2. 2Department of Medicine, Dermatology Service, St.-Luc Hospital
  3. 3Sacre Coeur Hospital of Montreal, University of Montreal, Montreal
  4. 4Department of Dermatology and Skin Science, University of British Columbia, Vancouver
  5. 5Division of Rheumatology, University of Alberta, Edmonton
  6. 6Division of Dermatology, University of Toronto, Toronto
  7. 7Division of Rheumatology, Department of Medicine, Western University of Canada, London
  8. 8Lynde Dermatology, Markham
  9. 9Faculty of Medicine, Memorial University of Newfoundland, St. John's
  10. 10Department of Medicine, Rheumatic Disease Unit, Centre Hospitalier de l'Universite de Montreal-CHUL
  11. 11Innovaderm Research, Montreal
  12. 12Department of Medicine, Rheumatic Disease Unit, Centre Hospitalier de l'Universite de Montreal (CHUM), Quebec, Canada

Abstract

Background Cardiovascular events (CVE) are increased in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and psoriasis (PsO) patients.

Objectives To determine the impact on CVE from methotrexate (MTX), TNF inhibitors (TNFi), corticosteroids (CS) and non-steroidal anti-inflammatory drugs (NSAIDs) (non-selective [ns-]NSAIDs and coxibs) in RA, PsA, and PsO.

Methods Medline, Embase, Cochrane databases were systematically searched. Observational studies and randomized trials reporting CVE (myocardial infarction [MI], heart failure [HF], strokes, and major cardiovascular adverse effects [MACEs]) in RA and in PsA/PsO patients treated with MTX, TNFi, CS and NSAIDs were considered. Studies with <400 patients, or < one year's duration, or including patients > mean age of 80 years were excluded. Random-effects meta-analyses were performed.

Results Out of 2630 references, 34 studies were included, 28 for RA and 6 for PsA/PsO. In RA, both TNFi (RR 0.70, 95% CI, 0.54-0.90; p=0.005) and MTX (RR 0.72, 95% CI, 0.57-0.91; p=0.007) decreased all CVE. TNFi decrease MI, strokes and MACEs. MTX decreases MI. NSAIDs increased all CVE (RR 1.18, 95% CI 1.01-1.38; p=0.04) and strokes. Among NSAIDs only rofecoxib (RR 1.58, 95% CI 1.24-2.00; p<0.001) significantly impacted all CVE. CS increased all CVE (RR 1.47, 95% CI 1.34-1.60; p<0.001), MI, HF, strokes, and MACEs. In PsA/PsO, systemic therapy decreased all CVE (RR 0.75, 95% CI, 0.63-0.91; p=0.003).

Conclusions In RA, TNFi and MTX are associated with a decrease in all CVE while CS are associated with an increase of all CVE. The deleterious effect of NSAIDs on CVE is related to rofecoxib. While current evidence suggests deleterious cardiovascular effects of CS and rofecoxib in RA, targeting inflammation with MTX and TNFi may be cardioprotective.

Disclosure of Interest C. Roubille Grant/research support: This study was supported by an unrestricted grant from AbbVie. Fellowship grants/bursary from the Foundation of the University of Montreal Hospital Center (CHUM)., V. Richer Grant/research support: This study was supported by an unrestricted grant from AbbVie., T. Starnino Grant/research support: This study was supported by an unrestricted grant from AbbVie., C. McCourt Grant/research support: This study was supported by an unrestricted grant from AbbVie. Salary for the fellowship in Vancouver was funded by a Fellowship from Janssen-Ortho Canada and the British Association of Dermatology., A. McFarlane Grant/research support: This study was supported by an unrestricted grant from AbbVie., P. Fleming Grant/research support: This study was supported by an unrestricted grant from AbbVie., S. Siu Grant/research support: This study was supported by an unrestricted grant from AbbVie., J. Kraft Grant/research support: This study was supported by an unrestricted grant from AbbVie. Investigator support from Abbvie, Amgen, Galderma, Janssen, Novartis., Consultant for: Abbvie, Amgen, Galderma, Janssen, Novartis, Leo Speakers bureau: Abbvie, Amgen, Galderma, Janssen, Leo., C. Lynde Grant/research support: This study was supported by an unrestricted grant from AbbVie. Investigator support: Abbvie, Amgen, Celgene, Janssen-Ortho, Novartis, Eli Lilly, Merck, Leo Pharma., Consultant for: Abbvie, Amgen, Celgene, Janssen-Ortho, Novartis, Eli Lilly, Merck, Leo Pharma., Speakers bureau: Abbvie, Amgen, Celgene, Janssen-Ortho, Novartis, Eli Lilly, Merck, Leo Pharma, J. Pope Grant/research support: This study was supported by an unrestricted grant from AbbVie. Research support from AbbVie, Actelion, Amgen, Astra Zeneca, Bayer, BMS, Celgene, Genentech, GSK, BMS, Jansen & Jansen, MedImmune, Mediquest, Novartis, Pfizer, Roche, United Chemicals Belgium., Consultant for: AbbVie, Actelion, Amgen, Astra Zeneca, Bayer, BMS, Celgene, Genentech, GSK, BMS, Jansen & Jansen, MedImmune, Mediquest, Novartis, Pfizer, Roche, United Chemicals Belgium., S. Keeling Grant/research support: This study was supported by an unrestricted grant from AbbVie. Unrestricted educational funding received from the following:Pfizer, Janssen, Astrazeneca, Roche., Consultant for: Participated in advisory boards as consultant for:Janssen, AbbVie, Roche, Amgen., W. Gulliver Grant/research support: study was supported by an unrestricted grant from AbbVie. Research support from Abbott/AbbVie, Actelion, Amgen, Astellas, Bio-K, Celgene, Galderma, Janssen, LEO Pharma, Merck/Schering, Novartis, Pfizer, Roche and Valeant., Consultant for: Abbott/AbbVie, Actelion, Amgen, Astellas, Bio-K, Celgene, Galderma, Janssen, LEO Pharma, Merck/Schering, Novartis, Pfizer, Roche and Valeant., Speakers bureau: Abbott/AbbVie, Actelion, Amgen, Astellas, Bio-K, Celgene, Galderma, Janssen, LEO Pharma, Merck/Schering, Novartis, Pfizer, Roche and Valeant, J. Dutz Grant/research support: This study was supported by an unrestricted grant from AbbVie. Research support Abbvie, Centocor, Janssen- Ortho, Novartis, ONO Pharmaceuticals, Roche., Consultant for: Janssen-Ortho, AbbVie Amgen, Leo, Roche Speakers bureau: Janssen-Ortho, AbbVie Amgen, Leo., L. Bessette Grant/research support: This study was supported by an unrestricted grant from AbbVie. Research support AbbVie, UCB, Janssen, and Amgen. Consultant for: AbbVie, UCB, Janssen, and Amgen., Speakers bureau: AbbVie, UCB, Janssen, and Amgen., R. Bissonnette Grant/research support: This study was supported by an unrestricted grant from AbbVie. Research grants and honoraria AbbVie, Amgen, Celgene, Eli-Lilly Galderma, Incyte, Janssen, Leo Pharma, Merck, Novartis, Pfizer, Tribute., Consultant for: AbbVie, Amgen, Celgene, Eli-Lilly Galderma, Incyte, Janssen, Leo Pharma, Merck, Novartis, Pfizer, Tribute., B. Haraoui Grant/research support: This study was supported by an unrestricted grant from AbbVie. Grant support from Abbvie, Amgen, BMS, Celgene, Janssen, Pfizer, Roche, UCB., Consultant for: Abbvie, Amgen, BMS, Celgene, Janssen, Pfizer, Roche, UCB.

DOI 10.1136/annrheumdis-2014-eular.5448

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